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Strengthening Health Outcomes for Foster Care Children

Robert M. La Follette School of Public Affairs UNIVERSITY OF WISCONSIN-MADISON. Strengthening Health Outcomes for Foster Care Children. Prepared for WI Department of Children and Families WI Department of Health Services. Tawsif Anam Susan Cosgrove Rebecca Chown Carlton Frost.

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Strengthening Health Outcomes for Foster Care Children

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  1. Robert M. • La Follette School of Public Affairs • UNIVERSITY OF WISCONSIN-MADISON Strengthening Health Outcomesfor Foster Care Children Prepared for WI Department of Children and Families WI Department of Health Services TawsifAnam Susan Cosgrove Rebecca Chown Carlton Frost May 2013

  2. Foster Care Medical Home Project • Federally funded joint pilot • Department of Children and Families • Department of Health Services • Implemented in 6 counties: expected to reach 3,550 children enrolled in Medicaid • Follows a medical home model

  3. Out-of-Home Care in Wisconsin (1) • State-supervised, county-administered (except Milwaukee County: state-administered) Foster Care Placement Settings 2011

  4. Out-of-Home Care in Wisconsin (2)

  5. Background: Health Outcomes • Risk factors: • Abuse, neglect, poverty • Parental mental illness or substance abuse • Placement instability • Higher prevalence: • Chronic physical ailments • Mental and behavioral illnesses

  6. The Medical Home Model • Does not imply a specific provider location • Based on effective care coordination across multiple participants in a health care system, and with external providers • Goal: improve quality, access and timeliness of healthcare for children in out-of-home care

  7. Research Questions • Prevalence of common childhood ailments • Receipt of routine health care services • Effects of placement status on hospital utilization rates • The Medicaid status of foster children before and after out-of-home care Our populations of interest are: • Children placed in out-of-home care at least once • Children covered by Medicaid in Wisconsin

  8. Research Methodology (1) • Data provided by WI Department of Health Services • Captures all children on Medicaid in WI from 2009 to 2011: • Medicaid eligibility • Foster care placement status • Services received • Datasets: • Foster children: 16,989 • Medicaid: 2% random sample = 12,870

  9. Research Methodology (2) • Data structure: • Tens of thousands • Recipient ID • Dozens to hundreds per recipient • Claim (ICN) • Claim (ICN) • Several to dozens per claim • Line Item • Line Item • Attributes specific to line item • Diagnoses • Procedures • ER, hosp. admission • First, last service dates

  10. Research Methodology (3) • Outcome measures

  11. ResultsCommon Chronic Illnesses

  12. ResultsCommon Mental Illnesses

  13. ResultsCommon Acute Diagnoses

  14. ResultsRoutine Medical Care

  15. ResultsHospital Utilization OHC Dataset (Entry or Exit in 2010)

  16. ResultsContinuity of Medicaid Coverage Last OHC Claim in 2010 First OHC Claim in 2010

  17. Limitations • Snapshot over short span of time; insufficient data for within-subject longitudinal analysis • No information on care continuity before/after window • No information on affliction prevalence, health care utilization during any period not enrolled in Medicaid or filed no claims • Comparable figures not available for all conditions of interest in general child population • No significance testing

  18. So what do we see? • Question 1a: higher prevalence of physical conditions? • Question 1b: higher prevalence of mental illness? • Question 2: lower rates of routine medical care? • Question 3: higher rates of hospital utilization? • Question 4: Discontinuity of care in Medicaid coverage?

  19. Recommendations The medical home model is an ideal framework to address the health needs of foster children. • Consistent routine care • Ensure initial screenings • Increase primary care access • Comprehensive mental health care • Coordinate behavioral health and primary care • Discuss needs of children with legal guardians

  20. Acknowledgements • Department of Children and Families • Fred-Ellen Bove • Devon Syrjanen • Department of Health Services • David Hoffert • Beth Wroblewski • La Follette School of Public Affairs • Prof. Andrew Reschovsky • Prof. Robert Haveman • Karen Faster • Social Science Computing Cooperative • Russell Dimond

  21. Robert M. • La Follette School of Public Affairs • UNIVERSITY OF WISCONSIN-MADISON Thank you! TawsifAnam Susan Cosgrove Rebecca Chown Carlton Frost May 2013

  22. Sample Data (abbreviated)

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